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Eur J Cardiothorac Surg 2009;35:191-192. doi:10.1016/j.ejcts.2008.10.017
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Does tricuspid valve pathophysiology affect outcome in patients having tricuspid valve interventions?

Hany Elsayed*, Michael Poullis

Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom

Received 2 August 2008; accepted 20 October 2008.

* Corresponding author. Address: 4 Isleham Close, Liverpool, L19 4XS, United Kingdom. Tel.: +44 7756985742; fax: +44 1512281616. (Email: hanyhassan77{at}hotmail.com).

Key Words: Tricuspid valve • Endocarditis • Valvulectomy

We read the article by Guenther et al. [1] named ‘Tricuspid valve surgery: a thirty-year assessment of early and late outcome’ with great interest and we must congratulate the authors for publishing a well described and informative study with the longest published time of follow-up for patients. However, one point needs to be addressed.

The authors did not mention the pathophysiology of tricuspid valve disease in their study as a cause of tricuspid valve dysfunction. We believe this should have been included in the univariate and multivariate analysis, as it has a significant impact on outcome for hospital mortality regardless of the intervention performed.

We believe that endocarditis as a cause of tricuspid valve pathology carries a much higher risk for mortality than other disorders implicated in tricuspid valve disease.

We agree with the authors that the paucity of indications for tricuspid valve replacement limits its implementation, but the recognition of tricuspid valve endocarditis as an epidemic among heroin addicts in Detroit between 1966 and 1968 rejuvenated interest in tricuspid valve surgery. Valve replacement combined with intravenous antibiotics failed to control the severe Gram-negative sepsis, yielding a mortality rate of 100% [2].

Although tricuspid valve repair or replacements are the main interventions for tricuspid valve pathologies, Arbulu et al. [3] introduced a new type of intervention for this subgroup of patients. In a series of 55 patients with tricuspid endocarditis secondary to pseudomonas aeruginosa, he removed the tricuspid valve without replacing it. Sixty-one percent of patients survived after 25 years.

We believe that including the pathophysiology of tricuspid valve disease as a risk factor for outcome in patients undergoing tricuspid valve intervention would make this study a solid reference for all surgeons involved in managing patients with this interesting pathology.

References

  1. Guenther T, Noebauer C, Mazzitelli D, Busch R, Tassani-Prell P, Lange R. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 2008;34:402-409.[Abstract/Free Full Text]
  2. Edmunds L. Cardiac surgery in the adult. New York: McGraw-Hill; 2004.
  3. Arbulu A, Thomas NW, Wilson RF. Valvulectomy without prosthetic replacement: a life saving operation for tricuspid pseudomonas endocarditis. J Thorac Cardiovasc Surg 1972;64(1):103-107.[Medline]




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